December 10, 2025 • 29 mins
In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams sits down with Paola Ballester, MD, pediatric hospitalist, medical director for utilization management, and senior physician advisor at a large, freestanding academic children’s hospital and regional pediatric referral center. Dr. Ballester is also the co-founder of EasyPA, an AI-driven platform designed to streamline prior authorization processes. Together, they explore how medical practices can tackle administrative burdens, leverage technology, and prepare for upcoming regulatory changes — all while improving patient access to care.
Key Takeaways
- 02:45 Dr. Ballester’s Unique Journey
From insurance claims adjuster to pediatric hospitalist — how her background shaped her expertise in utilization management and revenue cycle. - 06:27 The Pain Points of Prior Authorization
Why delays in prior auth lead to patient suffering and staff frustration, and why the current system is broken. - 08:01 Introducing EasyPA
How an AI-powered platform can detect prior auth requirements, reduce denials, and generate appeal letters and peer-to-peer talking points. - 11:37 The “220-Minute Case”
A real-world example of administrative burden: 19 email threads, 14 team members, and multiple failed appeals for one procedure. - 22:19 Preparing for Regulatory Changes
CMS’s new rules (57F) will require electronic prior auth by Jan 1, 2027 — what practices need to know now. - 17:22 Choosing the Right Tech Tools
Practical advice for administrators and clinicians on evaluating AI solutions and understanding your own data before investing. - 24:22 Leadership and Representation
Dr. Ballester’s advice for women in healthcare leadership: owning confidence, overcoming imposter syndrome, and defining success. - 26:35 Life Beyond Medicine
How being a basketball mom keeps Dr. Ballester grounded and why setting boundaries matters for work-life balance.
Resources & Links
- EasyPA
- Reach out to Paola Ballester, MD, on LinkedIn
- CMS Rule 57F - Details on upcoming electronic prior authorization requirements.
- MGMA prior authorization resources
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are back with another episode ofMGMA Insights, and I am so happy
to share a new guest, butsomeone I've gotten familiar
with over the last couple ofweeks and had conversations
with, and that's Doctor. PaulaBallester. Doctor.
(00:26):
Ballester is an MGMA member,also a hospitalist. She is at a
freestanding children's hospitalin St. Pete, Florida. And also,
also is an entrepreneur and isthe co founder of Easy PA. I
want to make sure I get thisright.
It's an AI driven platformdesigned to reduce friction in
(00:49):
prior authorization and theprocesses there. Doctor.
Ballester, you and I have talkeda couple of times recently, so
now we're on the podcasttogether. I just want to welcome
you to the show.
Paola Ballester (01:00):
Thank you so much. I'm excited to be here
with you, Daniel.
Daniel Williams (01:03):
Yeah, it's so good getting to catch up with
you. We're recording this rightafter Thanksgiving holidays.
Doctor Ballester was sharingwith me her signature
Thanksgiving dish, if I get thisright, the cornbread dressing.
Wow, that sounds so good.
Paola Ballester (01:21):
Takes stuffing to the next level.
Daniel Williams (01:23):
Yeah.
Paola Ballester (01:24):
I can't claim it as an original recipe, but
man, it always does the trick.
Daniel Williams (01:30):
Yeah. That is so cool. Well, bring us up to
speed then. When we have a gueston, we'd love to get to know a
little bit of the background. Soyou are a medical doctor.
Share with us a little bit aboutthat background and then I'll
follow-up and ask you a littlebit about that entrepreneurial
spirit because that's a littlebit different gear in the brain
(01:52):
there. So yeah, tell us aboutyour healthcare journey first.
Paola Ballester (01:56):
I would love to. So I am a practicing
pediatric hospitalist. I havebeen practicing now after
residency for almost fifteenyears. And along the way, kind
of got pulled into theutilization management and the
revenue cycle management space.So for the past, gosh, I think
eight, nine plus years now, Ihave also served as medical
(02:19):
director for utilizationmanagement at our institution
and senior physician advisor.
So there I have learned kind ofthe other side of medicine. Of
course, the clinical side stillinspires me and I love
pediatrics and getting to, youknow, be a part of really big
moments for families and helpingkiddos get better. But for me, I
(02:42):
have kind of an interesting,maybe unique is a better word,
background in that prior togoing to medical school, I
actually worked in the insuranceindustry for about four to five
years. And so, you know, I kindof the Venn diagram of my brain
at the time kind of had thisoverlap where many, many, I
would say the majority ofphysicians have no interest and
(03:07):
really would rather do prettymuch anything than deal with
insurance companies and dealwith kind of that piece of
medicine, this very criticalpiece of medicine that we
operate under. And so, becauseof my background, I was kind of
tapped into this role.
And so, have really been helpingour organization find better
(03:29):
ways to do things, learning moreand more daily about
regulations, compliance,insurance, you know, how we can
help our healthcare teamsdeliver care timely and
efficiently. So that's myjourney kind of through the past
couple of decades, I guess.
Daniel Williams (03:47):
Yeah. That is such an interesting background.
And that's what I love learningabout Guess. Because you and I
talked a week or so ago, and Idid not know about the insurance
background. Were you an agent oron the administrative side?
Or what were you?
Paola Ballester (04:03):
So believe it or not, my first job out of
undergrad, I was still kind offiguring out what I wanted to
do. I had gone into undergrad atthe University of Michigan
thinking I wanted to be aphysician. Both of my parents
are physicians. They neverpushed me towards medicine, but
I loved kids. I always knew thatfrom the beginning.
So I really my vision enteringday one into undergrad was to go
(04:27):
to med school and be apediatrician. Unfortunately,
freshman year of undergrad waschallenging and I really
struggled with my intro, I thinkchemistry class. And I had to
pull out of it and drop itbecause I couldn't cut it. And
so that kind of made me think,Oh gosh, I can't do this. I'm
not smart enough.
And I pivoted and startedthinking about other careers. My
(04:49):
degree was actually in sociologyin undergrad. So, as I was
trying to figure out what to do,what my next steps were,
obviously, you've got to pay thebills, you know, being a grown
up and finally being out ofcollege. So I was living in
Gainesville, Florida at the timeand Nationwide Insurance has a
big headquarters there. So, youknow, I started working as a
(05:11):
claims adjuster, believe it ornot, for auto accident claims.
I kind of requested and gotpulled into the medical side of
the car accident claims and hadserved in several roles there.
But that's kind of how I wasable to, as I was realizing I
really did want to go back toand go to medical school and I
had to go back and do all myprerequisite classes while I was
(05:33):
working full time. But that'show I was able to kind of get a
little bit of exposure andexperience in insurance, in
medical insurance, albeitthrough car insurance accidents.
Daniel Williams (05:43):
Yeah. I love that. What a great story. And it
is unique of all the doctorsI've spoken to. I don't know any
were claim adjusters prior Andto being a it also shows to your
resilience that you stuck it outand you finally mastered
chemistry, however you did it.
(06:05):
I don't know.
Paola Ballester (06:06):
And physics and organic chemistry. Oh yeah. It
was really, you know, we're allgrowing up at that age. I look
at teenagers now and remembervery fondly, but also with a lot
of trepidation, kind of thoseyears trying to figure it out on
your own and being responsibleand having study skills and all
that stuff. But I was able tofigure it out.
(06:26):
I'm glad that I did.
Daniel Williams (06:27):
Yeah. That's wonderful. So pivoting a little
bit here, you do wear that otherhat, which is an entrepreneurial
hat. So whether it was justhaving all the pajama time of
spending just so many hoursdoing administrative work, not
seeing clients or patients, orit was also part of that
(06:53):
insurance background. Get themoment to start a business?
And tell us about that business.
Paola Ballester (07:02):
Yeah. So, you know, over the years being in
the role that I'm in in thehospital, I have witnessed kind
of over and over and over again,docs, surgeons, you know, that
are needing to perform some typeof procedure, surgery, provide
care for patients. You know,these are patients that are
(07:24):
potentially suffering. They arewaiting, they're anxious and
watching the countless delaysgoing back and forth between the
healthcare teams trying tosubmit clean claims, requesting
prior authorization and precertification for services,
getting denied, having to dopeer to peer phone calls with
the insurance company to justifywhy that care is medically
(07:47):
necessary and needed. And thenthese back and forths, these
delays watching patients suffer,watching families, you know,
suffer, their parents getanxious, and the healthcare
team's frustrated, right?
And so I really started to thinkabout there has to be a better
way. My initial lens was reallyto help my institution, which
(08:07):
obviously I still do. But as Istarted kind of researching and
learning about the regulatoryshifts that are coming forth in
the next year or two, really sawan opportunity. So I started
speaking with one of mycolleagues at the hospital,
Doctor. Ralph Martello.
And we started brainstormingideas of how can we make this
better for practices, not justour institution, but for all
(08:30):
practices and all healthcareteams. So we met with our third
co founder, our CTO, Alex Vega,who is a genius of all things
tech. And we we told him, we wesaid, hey, let's meet for
sandwiches. So we met at a localdeli and Doctor. Martello and I
laid out kind of the currentstate.
We laid out our dream futureideal state. And we asked Alex,
(08:55):
is this feasible? Can you buildthis? And he said, absolutely,
without hesitation, Which kindof blew our minds because, you
know, neither of us are techfolk. You know, we've both been
dedicated physicians for theentirety of our careers.
Neither of us, you know, withany ventures outside of that,
really. And so it was reallyexciting. So we started to kind
(09:18):
of talk to local practices thatwe are, you know, have
colleagues and friends that workin and started kind of sharing
our ideas. What do you thinkabout this? And immediately got
a lot of interest and heard alot of stories and a lot of pain
points in local practices.
And that's kind of how we wereborn from real lived pain. And
(09:40):
this common experience thatevery single practice we speak
with is suffering the sameproblems. This is widespread.
This is well known. This is notjust pockets or one offs.
So we're really excited aboutwhat we're building. We've built
a software platform that canhelp practices through the
entire life cycle of priorauthorization. So everything
(10:00):
from detecting whether or not aprior authorization is even
needed prior to a surgery. We'veseen many practices where they
have no way of knowing if aprior authorization is even
needed. So they just kind ofthrow spaghetti against the wall
and see if it sticks.
Right? Did we need it or not?They submit as a means to even
verify if it's needed or not. Sowe can tell them if it's needed
(10:23):
or not. We can help themstrengthen the chance of
authorization on first pass byby demonstrating kind of risk of
denial and generating a scoreand showing them really
practical ways, Hey, this is thewrong code.
Hey, this is the wrong Youdidn't support or attach the
necessary documentation. Youdidn't include the physical
therapy notes. You didn'tinclude the MRI report. To help
(10:45):
them strengthen that claimbefore they even submit it to
reduce that chance of denialfrom the the get go. And then
through all the way through, ifthey receive a denial, because
we know denials are inevitable,we can help them generate peer
to peer talking points.
So for that conversation withthe insurance company or an
appeal letter if needed, wherewe can quickly and intelligently
(11:09):
cross reference payer policies,payer contracts, and evidence
from the literature to help themmore efficiently insert
intelligence into the processand all the way through post
bill denial. So, you perform theprocedure, you got the
authorization successfully, butyou still got a denial on the
back end. We can help you fightthat too. So it's been really
(11:31):
exciting. We're growing anddeveloping the product every
day, but that's us in anutshell.
Daniel Williams (11:37):
Yeah. That is so interesting. Now you told me,
it was about a week or so agowhen we talked and you told me
about a particular anecdote thatI think probably everybody who's
a medical practice administratoror a clinician can nod their
head approvingly. I think if I'mhearing it right in my head, it
(11:57):
was the 99 email case orsomething like that. How refer
do to it?
Paola Ballester (12:03):
Yeah. So we calculated about 220 minutes of
time on paperwork andadministrative burden to help
get one patient one procedurethey needed. So there was over
about a two month span, over 19trail of emails, four 14 members
(12:27):
of four different teams withinthe system having multiple phone
calls, conference calls, onefailed peer to peer call, one
failed denial and appeal. Andthat was obviously, you know,
pre implementation of ourproduct, but that was one of the
big drivers. And that was areally big part of our story to
(12:48):
say like, can't be the best wecan do.
Daniel Williams (12:53):
Right. It didn't go through y'all's
system, your program. If it had,I mean, it's just hypothetically
speaking, but what would havechanged? Just give us an idea
because everybody who'slistening is probably going,
yeah, I've been through that.Yep.
We did that.
Paola Ballester (13:08):
What would So I think Yeah. Yeah. I think, you
know, the big difference is isthat, you know, we have such a
mismatch of expertise in thisrealm of healthcare. We have
physicians who are the expertsin clinical care. They know the
guidelines, they know thetreatments that are needed.
And then they say, We need Xprocedure. And then they hand
(13:29):
that off to their team, right?Whether that's an office
administrator or someone intheir practice that is tasked
with performing these functions,they submit the claims. And like
we talked about before, theydon't have expertise or
knowledge of healthcarepolicies, policy bulletin
contracts. Even the mostexperienced practice manager
that's been doing it for thirtyyears cannot possibly keep pace
(13:53):
with the number of insurancepolicies, the differences in
contracts, the constant updatesand payer requirements.
And so this is where we saw thebiggest mismatch because we have
no role in healthcare whereanyone can possibly have the
amount of knowledge needed toquickly and efficiently process
these prior authorizations andappeals. So that's why we built
(14:17):
this is the perfect use case forAI and for automation because we
can quickly, efficiently, andintelligently look at the
clinic's own insurance contractwith the payer, with other
policy bulletins and otherpolicies that are published by
the payers, and quickly say,Hey, for this procedure, you
(14:39):
need to show X, Y, and Z, ratherthan just guessing, right?
Because that's what folks andteens are doing right now is
they're doing their best guessbased on their experience. And a
lot of times, if they're doingthe same types of cases over and
over, right, they can get goodat it because they realize from,
you know, past trial and error,right, what they need to do next
(15:00):
time. But I think our productreally helps them do it right
from the beginning.
Reducing denials because you'vegot a clean claim from the
beginning is one of the mosteffective ways to improve your
operations and, you know, reducerevenue lead too, only
notwithstanding the mostimportant thing is get your
(15:20):
patients quicker access to care.
Daniel Williams (15:22):
You had sent me some information and we spoke a
week ago and you were telling meyou've worked with some
practices trying to modernizethe way that they address this.
How do those conversations go?Give us a little insight into
the conversation, the kind ofquestions or pain points that
the practices are sharing withyou, and how you're helping them
(15:43):
see it with new eyes through anew lens with this new
technology and the new platform.
Paola Ballester (15:50):
And it's such an important question because I
think right now there is, youknow, we're in the AI boom.
We're trying to figure out inhealthcare how the heck do we do
this responsibly? How do we doit securely? How do we not
compromise patient data? And,you know, there are so many
shiny toys out there.
It's like, well, what's noise?What can really help my
(16:12):
practice? So I think for us, ouradvantage is we're physician
built. So we started fromknowing the pain and
experiencing it, knowing thefrustrations, knowing the
workflows firsthand. And so thatgives us an automatic advantage
because we are, you know, asthey say in lean, right?
We're at the Gimba. We don'thave to go there because we're
(16:32):
already there. So we understandwhat's happening. So when we've
been speaking with practicesthat are piloting our product,
it's been great because they'vefantastic partners, so
supportive, giving us realfeedback. Hey, this part of the
interface would be easier if youcould do X, Y, or Z.
So not only making it morestreamlined so that it's more
(16:54):
user friendly because we don'twant to introduce friction,
right? And the whole goal of ourproduct is to reduce friction.
So hearing that feedback torefine the product has been
super important. But really,it's just been that relief
almost that we are hearing fromthe practices that we're
delivering what what our goalis, right, is to make it easier,
make it faster, and really tohelp the teams feel more
(17:18):
confident in what they're doingrather than guessing. Mhmm.
Daniel Williams (17:22):
You brought up a great point, one that I'm
challenging myself with. Thereare so many new shiny toys out
there right now, And it isoverwhelming. And that's one
thing at MGMA we're attemptingto do is to provide a platform
(17:42):
where our members can go andwe'll provide them with some
guidance on what's real, and noteven what's real, but what fits
what their needs are. So puttingyour clinician hat on and your
administrative hat on from thatside of it, because you're
(18:02):
probably being inundated withother AI tools and other
technology tools. What are someprocesses that an administrator
or clinician can go through tofigure out what really is the
right choice?
Because there are so manychoices out there and you don't
want to spend so much timepicking the wrong one. How would
(18:25):
you address that? Not looking atit from the easy PA side, but
from the administrator side.
Paola Ballester (18:32):
Sure. I think data is the most important
thing. Right? You have tounderstand your own data before
you can identify youropportunities for improvement.
So, you know, we have spokenwith a lot of practices now.
And I think one of the thingsthat is most surprising to me
and is also a struggle in my owninstitution is that we don't
(18:54):
have good data. So you if youask practices, what is your
first pass authorization successrate? How many claims do you
currently have pending? How manyclaims you are you late you
know, do you need to follow-upon? How many dollars are at
issue?
What is your average time tosubmit and get authorization?
Blank stares. And it's reallyhard because there's not a lot
(19:17):
of support out there to helppractices tell that story and to
understand their opportunities.And when you look at it from
from an administrative andexecutive perspective, you know,
there are opportunities such asgold carding with insurance
companies where if you're ableto demonstrate that you have a
really high success rate withyour claims and with your
appeals, and you can demonstratethat, then you can get kind of,
(19:41):
you know, a gold card whereyou'll get to kind of bypass
some of the processes becauseyou've kind of been vetted and
shown that you're what you'redoing is right. And clinics
don't even have a way to showthat because they they're not
tracking the data.
So I think first and foremost isyou have to have data.
Obviously, going back to wearingmy entrepreneur hat, that was
one of the biggest things wedecided we had to build for the
(20:04):
clinic so that they would beable to understand their pain
points and understand trends.What payers are causing the most
problems? What codes are causingthe most problems? Where are we
losing the most revenue?
And things like that. So we havebuilt all of that out very
intentionally to arm clinicswith really understanding their
own opportunities. So I thinkthose are, that's probably the
(20:26):
biggest part for me is reallyunderstanding your own data and
your own process. We've spokenwith many clinics where, you
know, if you're speaking withphysician leadership, for
example, they don't even knowtheir process. They just know
they request something and thenmagic happens.
Their team makes the magichappen. They don't they may not
even know about the hours andthe frustration and the portal
(20:47):
popping and the faxes and thephone calls because that magic
is done by other members oftheir team. And so, you know,
it's really getting at theGemba, right, and understanding
what your team's pain pointsare. And it's really hard to do
that without data.
Daniel Williams (21:03):
Yeah, it is. For anybody who doesn't know
what Gimba is, just to definewhat is Gimba for any of our
listeners who might be trying totype it in right now to figure
out what that is. No.
Paola Ballester (21:17):
In in lean methodology, when you're really
learning how to improvepractice, you know, practices
and and processes andoperations. Getting to the Gemba
means you've got to go to wherethe action is happening, where
that process is happening.You've got to understand every
touch point, every piece of theprocess. You can't just know the
start and the end. You've got toknow where does that claim go?
(21:40):
Who's the one that's initiallymaking that request? How do they
do it? Where do they do it? Howmuch time does it take? What's
the next step when they hearback?
How do they log that or enterit? What system is tracking it
and really mapping out andreally understanding it. You
have to understand all of thosepieces to really understand your
opportunities for improving theprocess.
Daniel Williams (22:02):
Okay. Before we switch gears, I have a couple of
questions that aren't related toprior authorization.
Paola Ballester (22:08):
But before
Daniel Williams (22:11):
we switch gears, is there anything I
didn't ask you about prior author about EasyPA that you wanted
to share with us about that?
Paola Ballester (22:19):
Yeah. I think the big thing is for any, you
know, any healthcare leaders,clinic, you know, executives who
are listening, I think there isa lot of regulatory changes
coming. And so this to me is theperfect time for kind of digital
transformations in healthcarebecause for 30+ years, it's been
(22:45):
the same thing. We've been doingthings the same way. There's
been no modernization at all.
But now the Center for Medicareand Medicaid Services, if you
look up 0057- F, they arerequiring that there is
increased transparency andproved processes in the prior
(23:06):
authorization spacespecifically. So by 01/01/2027,
all insurance companies aregoing to be required to be able
to transmit prior authorizationselectronically, which is going
to be a huge shift. They'regoing to have to turn those non
urgent requests around in sevendays, whereas now it's at least
fourteen days for most routinerequests. And there has to be
(23:27):
improved transparency andvisibility. So I think the great
thing for us in healthcare rightnow is we finally have
regulatory pressure forcingchange in this really archaic
space.
So it's a beautiful time andopportunity for practices to
leverage that and to improvetheir own processes so that they
(23:48):
can benefit from that, right? Ifyour practice is still faxing
and portal hopping, once theinsurance companies are required
to do these electronictransmissions, you're really
missing out on an opportunity todecrease that turnaround time
for your patients and to improvethat process for your staff. So
I think that's another thingthat I would encourage, leaders
(24:11):
out there listening to look intoand to really come up with a
plan for how they're going toleverage that for their own
practice, because we know thatless than 0.5% of practices are
ready today.
Daniel Williams (24:22):
Wow. Okay. So switching gears.
Paola Ballester (24:26):
Yes.
Daniel Williams (24:27):
We did talk about something really
interesting. I think this can behelpful to our women listeners.
You talked about how a lot oftimes in very high level
meetings that you're in inhealth care, in the
entrepreneurial setting, youhave found yourself often the
only woman in some of thesemeetings. But you have had an
(24:48):
incredibly successful career. Sowhat advice can you give to our
women listeners today in howthey navigate that space, how
they succeed in healthcare,succeed in the entrepreneurial
world?
What have you leaned into tofind that success?
Paola Ballester (25:05):
Oh, that's such a great question and probably a
topic of for an entire series ofRight? But I think, you know,
every person should define theirown success individually. And I
think, you know, for women thatwant to and are in leadership
roles is to own theirconfidence, own their courage,
(25:28):
own their expertise. And I thinkto not shy away from
opportunities, not shy away fromchallenges. We deserve to be in
the spaces just as much asanyone else.
I think a lot of times women,particularly and more so than
men, have imposter impostersyndrome and kind of worry that
(25:49):
they're not qualified, thatthey're not deserving of those
opportunities. We know thatthere are inherent systemic
barriers as well. And so I justchallenge women to believe in
themselves first and not to shyaway from, you know,
representing themselves,demanding their worth and their
value and showing up in thosespaces and showing, you know,
(26:13):
what we can do. From everythingon the clinical side, we know
that many studies have shownbetter outcomes with female
physicians, surgeons, and we areincreasingly taking up and
expanding in our leadershipcapabilities and roles. And so
own that and be a part of thatand tell your story.
(26:33):
It's been an interesting journeyso far, and and I'm excited to
kind of help represent that forother women.
Daniel Williams (26:39):
Yeah. Last question. Because I really do
like to get to know the guestoutside of the work they do. So
you were sharing with me thatyou are an enthusiastic
basketball mom, and I'm a I'm aformer cheer dad. My daughter
Nice.
Was a cheerleader both in highschool and college. And so I was
(27:00):
cheering along with her, and wejust met at Thanksgiving and
went So through some of thecheers together what has that
experience been like where youcan really focus on the kids and
watching them play basketball,maybe show them how to make a
good two handed bounce pass,that sort of thing. But what
what has that been like?
Paola Ballester (27:21):
So I am the proud mom to an almost 13 year
old son named MJ, and he is anavid basketball player. This is
the first year that he's beenable to play for his middle
school team, which has been somuch fun. He's also been
involved in many rec leagues andAAU teams. So, you know, I think
(27:45):
even going back to your previousquestion, right, is how do we do
it all? And I think it's youhave to have your firm
boundaries.
What is important to you? Whatis non negotiable? And how do
you make everything else workaround it? And I think to me,
the biggest parts of my successI attribute to, you know, having
(28:05):
community and that's chosenfamily and community, my
girlfriends, my family that areall so incredibly supportive and
cheer for me every step of theway. But also my son because
he's my motivation.
He's why I do everything that Ido. He's why I've chosen the
role that I've chosen because tome personally, it was really
(28:26):
important that I can go to thosebasketball games and I can go to
his tournaments. And yeah, ofcourse, I miss a few every now
and then. I have to workweekends. I have to work night
shifts, But I do my best toprioritize scheduling my
clinical shifts and my meetingsin times that won't conflict
with me being able to be hisnumber one fan.
(28:47):
So, I am one of those loud momsin the stands. I'm cheering. I
have an amazing group ofbasketball moms that we've all
become close and friends with,and we love, you know, cheering
our boys on together. So thoseare the things that fill my cup
and bring me a lot of joyoutside of the daily kind of
grind of medical practice andentrepreneurial life. Those are
(29:09):
the things that keep me centeredand grounded and really bring me
a lot of joy.
Daniel Williams (29:14):
That is so cool. Well, Doctor. Paula
Ballester, a hospitalist and anentrepreneur or founder of
EasyPA, thanks for joining ustoday.
Paola Ballester (29:24):
Absolutely. It was a pleasure. I really
appreciate you.
Daniel Williams (29:27):
Yeah. Everybody listening, we're going to put a
lot of information in theepisode show notes. We might
even put Doctor. Ballester'srecipes from Thanksgiving, if
we're lucky. Who knows?
But I just want to say, thankyou all for being MGMA podcast
listeners.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are back with another episode ofMGMA Insights, and I am so happy
to share a new guest, butsomeone I've gotten familiar
with over the last couple ofweeks and had conversations
with, and that's Doctor. PaulaBallester. Doctor.
(00:26):
Ballester is an MGMA member,also a hospitalist. She is at a
freestanding children's hospitalin St. Pete, Florida. And also,
also is an entrepreneur and isthe co founder of Easy PA. I
want to make sure I get thisright.
It's an AI driven platformdesigned to reduce friction in
(00:49):
prior authorization and theprocesses there. Doctor.
Ballester, you and I have talkeda couple of times recently, so
now we're on the podcasttogether. I just want to welcome
you to the show.
Paola Ballester (01:00):
Thank you so much. I'm excited to be here
with you, Daniel.
Daniel Williams (01:03):
Yeah, it's so good getting to catch up with
you. We're recording this rightafter Thanksgiving holidays.
Doctor Ballester was sharingwith me her signature
Thanksgiving dish, if I get thisright, the cornbread dressing.
Wow, that sounds so good.
Paola Ballester (01:21):
Takes stuffing to the next level.
Daniel Williams (01:23):
Yeah.
Paola Ballester (01:24):
I can't claim it as an original recipe, but
man, it always does the trick.
Daniel Williams (01:30):
Yeah. That is so cool. Well, bring us up to
speed then. When we have a gueston, we'd love to get to know a
little bit of the background. Soyou are a medical doctor.
Share with us a little bit aboutthat background and then I'll
follow-up and ask you a littlebit about that entrepreneurial
spirit because that's a littlebit different gear in the brain
(01:52):
there. So yeah, tell us aboutyour healthcare journey first.
Paola Ballester (01:56):
I would love to. So I am a practicing
pediatric hospitalist. I havebeen practicing now after
residency for almost fifteenyears. And along the way, kind
of got pulled into theutilization management and the
revenue cycle management space.So for the past, gosh, I think
eight, nine plus years now, Ihave also served as medical
(02:19):
director for utilizationmanagement at our institution
and senior physician advisor.
So there I have learned kind ofthe other side of medicine. Of
course, the clinical side stillinspires me and I love
pediatrics and getting to, youknow, be a part of really big
moments for families and helpingkiddos get better. But for me, I
(02:42):
have kind of an interesting,maybe unique is a better word,
background in that prior togoing to medical school, I
actually worked in the insuranceindustry for about four to five
years. And so, you know, I kindof the Venn diagram of my brain
at the time kind of had thisoverlap where many, many, I
would say the majority ofphysicians have no interest and
(03:07):
really would rather do prettymuch anything than deal with
insurance companies and dealwith kind of that piece of
medicine, this very criticalpiece of medicine that we
operate under. And so, becauseof my background, I was kind of
tapped into this role.
And so, have really been helpingour organization find better
(03:29):
ways to do things, learning moreand more daily about
regulations, compliance,insurance, you know, how we can
help our healthcare teamsdeliver care timely and
efficiently. So that's myjourney kind of through the past
couple of decades, I guess.
Daniel Williams (03:47):
Yeah. That is such an interesting background.
And that's what I love learningabout Guess. Because you and I
talked a week or so ago, and Idid not know about the insurance
background. Were you an agent oron the administrative side?
Or what were you?
Paola Ballester (04:03):
So believe it or not, my first job out of
undergrad, I was still kind offiguring out what I wanted to
do. I had gone into undergrad atthe University of Michigan
thinking I wanted to be aphysician. Both of my parents
are physicians. They neverpushed me towards medicine, but
I loved kids. I always knew thatfrom the beginning.
So I really my vision enteringday one into undergrad was to go
(04:27):
to med school and be apediatrician. Unfortunately,
freshman year of undergrad waschallenging and I really
struggled with my intro, I thinkchemistry class. And I had to
pull out of it and drop itbecause I couldn't cut it. And
so that kind of made me think,Oh gosh, I can't do this. I'm
not smart enough.
And I pivoted and startedthinking about other careers. My
(04:49):
degree was actually in sociologyin undergrad. So, as I was
trying to figure out what to do,what my next steps were,
obviously, you've got to pay thebills, you know, being a grown
up and finally being out ofcollege. So I was living in
Gainesville, Florida at the timeand Nationwide Insurance has a
big headquarters there. So, youknow, I started working as a
(05:11):
claims adjuster, believe it ornot, for auto accident claims.
I kind of requested and gotpulled into the medical side of
the car accident claims and hadserved in several roles there.
But that's kind of how I wasable to, as I was realizing I
really did want to go back toand go to medical school and I
had to go back and do all myprerequisite classes while I was
(05:33):
working full time. But that'show I was able to kind of get a
little bit of exposure andexperience in insurance, in
medical insurance, albeitthrough car insurance accidents.
Daniel Williams (05:43):
Yeah. I love that. What a great story. And it
is unique of all the doctorsI've spoken to. I don't know any
were claim adjusters prior Andto being a it also shows to your
resilience that you stuck it outand you finally mastered
chemistry, however you did it.
(06:05):
I don't know.
Paola Ballester (06:06):
And physics and organic chemistry. Oh yeah. It
was really, you know, we're allgrowing up at that age. I look
at teenagers now and remembervery fondly, but also with a lot
of trepidation, kind of thoseyears trying to figure it out on
your own and being responsibleand having study skills and all
that stuff. But I was able tofigure it out.
(06:26):
I'm glad that I did.
Daniel Williams (06:27):
Yeah. That's wonderful. So pivoting a little
bit here, you do wear that otherhat, which is an entrepreneurial
hat. So whether it was justhaving all the pajama time of
spending just so many hoursdoing administrative work, not
seeing clients or patients, orit was also part of that
(06:53):
insurance background. Get themoment to start a business?
And tell us about that business.
Paola Ballester (07:02):
Yeah. So, you know, over the years being in
the role that I'm in in thehospital, I have witnessed kind
of over and over and over again,docs, surgeons, you know, that
are needing to perform some typeof procedure, surgery, provide
care for patients. You know,these are patients that are
(07:24):
potentially suffering. They arewaiting, they're anxious and
watching the countless delaysgoing back and forth between the
healthcare teams trying tosubmit clean claims, requesting
prior authorization and precertification for services,
getting denied, having to dopeer to peer phone calls with
the insurance company to justifywhy that care is medically
(07:47):
necessary and needed. And thenthese back and forths, these
delays watching patients suffer,watching families, you know,
suffer, their parents getanxious, and the healthcare
team's frustrated, right?
And so I really started to thinkabout there has to be a better
way. My initial lens was reallyto help my institution, which
(08:07):
obviously I still do. But as Istarted kind of researching and
learning about the regulatoryshifts that are coming forth in
the next year or two, really sawan opportunity. So I started
speaking with one of mycolleagues at the hospital,
Doctor. Ralph Martello.
And we started brainstormingideas of how can we make this
better for practices, not justour institution, but for all
(08:30):
practices and all healthcareteams. So we met with our third
co founder, our CTO, Alex Vega,who is a genius of all things
tech. And we we told him, we wesaid, hey, let's meet for
sandwiches. So we met at a localdeli and Doctor. Martello and I
laid out kind of the currentstate.
We laid out our dream futureideal state. And we asked Alex,
(08:55):
is this feasible? Can you buildthis? And he said, absolutely,
without hesitation, Which kindof blew our minds because, you
know, neither of us are techfolk. You know, we've both been
dedicated physicians for theentirety of our careers.
Neither of us, you know, withany ventures outside of that,
really. And so it was reallyexciting. So we started to kind
(09:18):
of talk to local practices thatwe are, you know, have
colleagues and friends that workin and started kind of sharing
our ideas. What do you thinkabout this? And immediately got
a lot of interest and heard alot of stories and a lot of pain
points in local practices.
And that's kind of how we wereborn from real lived pain. And
(09:40):
this common experience thatevery single practice we speak
with is suffering the sameproblems. This is widespread.
This is well known. This is notjust pockets or one offs.
So we're really excited aboutwhat we're building. We've built
a software platform that canhelp practices through the
entire life cycle of priorauthorization. So everything
(10:00):
from detecting whether or not aprior authorization is even
needed prior to a surgery. We'veseen many practices where they
have no way of knowing if aprior authorization is even
needed. So they just kind ofthrow spaghetti against the wall
and see if it sticks.
Right? Did we need it or not?They submit as a means to even
verify if it's needed or not. Sowe can tell them if it's needed
(10:23):
or not. We can help themstrengthen the chance of
authorization on first pass byby demonstrating kind of risk of
denial and generating a scoreand showing them really
practical ways, Hey, this is thewrong code.
Hey, this is the wrong Youdidn't support or attach the
necessary documentation. Youdidn't include the physical
therapy notes. You didn'tinclude the MRI report. To help
(10:45):
them strengthen that claimbefore they even submit it to
reduce that chance of denialfrom the the get go. And then
through all the way through, ifthey receive a denial, because
we know denials are inevitable,we can help them generate peer
to peer talking points.
So for that conversation withthe insurance company or an
appeal letter if needed, wherewe can quickly and intelligently
(11:09):
cross reference payer policies,payer contracts, and evidence
from the literature to help themmore efficiently insert
intelligence into the processand all the way through post
bill denial. So, you perform theprocedure, you got the
authorization successfully, butyou still got a denial on the
back end. We can help you fightthat too. So it's been really
(11:31):
exciting. We're growing anddeveloping the product every
day, but that's us in anutshell.
Daniel Williams (11:37):
Yeah. That is so interesting. Now you told me,
it was about a week or so agowhen we talked and you told me
about a particular anecdote thatI think probably everybody who's
a medical practice administratoror a clinician can nod their
head approvingly. I think if I'mhearing it right in my head, it
(11:57):
was the 99 email case orsomething like that. How refer
do to it?
Paola Ballester (12:03):
Yeah. So we calculated about 220 minutes of
time on paperwork andadministrative burden to help
get one patient one procedurethey needed. So there was over
about a two month span, over 19trail of emails, four 14 members
(12:27):
of four different teams withinthe system having multiple phone
calls, conference calls, onefailed peer to peer call, one
failed denial and appeal. Andthat was obviously, you know,
pre implementation of ourproduct, but that was one of the
big drivers. And that was areally big part of our story to
(12:48):
say like, can't be the best wecan do.
Daniel Williams (12:53):
Right. It didn't go through y'all's
system, your program. If it had,I mean, it's just hypothetically
speaking, but what would havechanged? Just give us an idea
because everybody who'slistening is probably going,
yeah, I've been through that.Yep.
We did that.
Paola Ballester (13:08):
What would So I think Yeah. Yeah. I think, you
know, the big difference is isthat, you know, we have such a
mismatch of expertise in thisrealm of healthcare. We have
physicians who are the expertsin clinical care. They know the
guidelines, they know thetreatments that are needed.
And then they say, We need Xprocedure. And then they hand
(13:29):
that off to their team, right?Whether that's an office
administrator or someone intheir practice that is tasked
with performing these functions,they submit the claims. And like
we talked about before, theydon't have expertise or
knowledge of healthcarepolicies, policy bulletin
contracts. Even the mostexperienced practice manager
that's been doing it for thirtyyears cannot possibly keep pace
(13:53):
with the number of insurancepolicies, the differences in
contracts, the constant updatesand payer requirements.
And so this is where we saw thebiggest mismatch because we have
no role in healthcare whereanyone can possibly have the
amount of knowledge needed toquickly and efficiently process
these prior authorizations andappeals. So that's why we built
(14:17):
this is the perfect use case forAI and for automation because we
can quickly, efficiently, andintelligently look at the
clinic's own insurance contractwith the payer, with other
policy bulletins and otherpolicies that are published by
the payers, and quickly say,Hey, for this procedure, you
(14:39):
need to show X, Y, and Z, ratherthan just guessing, right?
Because that's what folks andteens are doing right now is
they're doing their best guessbased on their experience. And a
lot of times, if they're doingthe same types of cases over and
over, right, they can get goodat it because they realize from,
you know, past trial and error,right, what they need to do next
(15:00):
time. But I think our productreally helps them do it right
from the beginning.
Reducing denials because you'vegot a clean claim from the
beginning is one of the mosteffective ways to improve your
operations and, you know, reducerevenue lead too, only
notwithstanding the mostimportant thing is get your
(15:20):
patients quicker access to care.
Daniel Williams (15:22):
You had sent me some information and we spoke a
week ago and you were telling meyou've worked with some
practices trying to modernizethe way that they address this.
How do those conversations go?Give us a little insight into
the conversation, the kind ofquestions or pain points that
the practices are sharing withyou, and how you're helping them
(15:43):
see it with new eyes through anew lens with this new
technology and the new platform.
Paola Ballester (15:50):
And it's such an important question because I
think right now there is, youknow, we're in the AI boom.
We're trying to figure out inhealthcare how the heck do we do
this responsibly? How do we doit securely? How do we not
compromise patient data? And,you know, there are so many
shiny toys out there.
It's like, well, what's noise?What can really help my
(16:12):
practice? So I think for us, ouradvantage is we're physician
built. So we started fromknowing the pain and
experiencing it, knowing thefrustrations, knowing the
workflows firsthand. And so thatgives us an automatic advantage
because we are, you know, asthey say in lean, right?
We're at the Gimba. We don'thave to go there because we're
(16:32):
already there. So we understandwhat's happening. So when we've
been speaking with practicesthat are piloting our product,
it's been great because they'vefantastic partners, so
supportive, giving us realfeedback. Hey, this part of the
interface would be easier if youcould do X, Y, or Z.
So not only making it morestreamlined so that it's more
(16:54):
user friendly because we don'twant to introduce friction,
right? And the whole goal of ourproduct is to reduce friction.
So hearing that feedback torefine the product has been
super important. But really,it's just been that relief
almost that we are hearing fromthe practices that we're
delivering what what our goalis, right, is to make it easier,
make it faster, and really tohelp the teams feel more
(17:18):
confident in what they're doingrather than guessing. Mhmm.
Daniel Williams (17:22):
You brought up a great point, one that I'm
challenging myself with. Thereare so many new shiny toys out
there right now, And it isoverwhelming. And that's one
thing at MGMA we're attemptingto do is to provide a platform
(17:42):
where our members can go andwe'll provide them with some
guidance on what's real, and noteven what's real, but what fits
what their needs are. So puttingyour clinician hat on and your
administrative hat on from thatside of it, because you're
(18:02):
probably being inundated withother AI tools and other
technology tools. What are someprocesses that an administrator
or clinician can go through tofigure out what really is the
right choice?
Because there are so manychoices out there and you don't
want to spend so much timepicking the wrong one. How would
(18:25):
you address that? Not looking atit from the easy PA side, but
from the administrator side.
Paola Ballester (18:32):
Sure. I think data is the most important
thing. Right? You have tounderstand your own data before
you can identify youropportunities for improvement.
So, you know, we have spokenwith a lot of practices now.
And I think one of the thingsthat is most surprising to me
and is also a struggle in my owninstitution is that we don't
(18:54):
have good data. So you if youask practices, what is your
first pass authorization successrate? How many claims do you
currently have pending? How manyclaims you are you late you
know, do you need to follow-upon? How many dollars are at
issue?
What is your average time tosubmit and get authorization?
Blank stares. And it's reallyhard because there's not a lot
(19:17):
of support out there to helppractices tell that story and to
understand their opportunities.And when you look at it from
from an administrative andexecutive perspective, you know,
there are opportunities such asgold carding with insurance
companies where if you're ableto demonstrate that you have a
really high success rate withyour claims and with your
appeals, and you can demonstratethat, then you can get kind of,
(19:41):
you know, a gold card whereyou'll get to kind of bypass
some of the processes becauseyou've kind of been vetted and
shown that you're what you'redoing is right. And clinics
don't even have a way to showthat because they they're not
tracking the data.
So I think first and foremost isyou have to have data.
Obviously, going back to wearingmy entrepreneur hat, that was
one of the biggest things wedecided we had to build for the
(20:04):
clinic so that they would beable to understand their pain
points and understand trends.What payers are causing the most
problems? What codes are causingthe most problems? Where are we
losing the most revenue?
And things like that. So we havebuilt all of that out very
intentionally to arm clinicswith really understanding their
own opportunities. So I thinkthose are, that's probably the
(20:26):
biggest part for me is reallyunderstanding your own data and
your own process. We've spokenwith many clinics where, you
know, if you're speaking withphysician leadership, for
example, they don't even knowtheir process. They just know
they request something and thenmagic happens.
Their team makes the magichappen. They don't they may not
even know about the hours andthe frustration and the portal
(20:47):
popping and the faxes and thephone calls because that magic
is done by other members oftheir team. And so, you know,
it's really getting at theGemba, right, and understanding
what your team's pain pointsare. And it's really hard to do
that without data.
Daniel Williams (21:03):
Yeah, it is. For anybody who doesn't know
what Gimba is, just to definewhat is Gimba for any of our
listeners who might be trying totype it in right now to figure
out what that is. No.
Paola Ballester (21:17):
In in lean methodology, when you're really
learning how to improvepractice, you know, practices
and and processes andoperations. Getting to the Gemba
means you've got to go to wherethe action is happening, where
that process is happening.You've got to understand every
touch point, every piece of theprocess. You can't just know the
start and the end. You've got toknow where does that claim go?
(21:40):
Who's the one that's initiallymaking that request? How do they
do it? Where do they do it? Howmuch time does it take? What's
the next step when they hearback?
How do they log that or enterit? What system is tracking it
and really mapping out andreally understanding it. You
have to understand all of thosepieces to really understand your
opportunities for improving theprocess.
Daniel Williams (22:02):
Okay. Before we switch gears, I have a couple of
questions that aren't related toprior authorization.
Paola Ballester (22:08):
But before
Daniel Williams (22:11):
we switch gears, is there anything I
didn't ask you about prior author about EasyPA that you wanted
to share with us about that?
Paola Ballester (22:19):
Yeah. I think the big thing is for any, you
know, any healthcare leaders,clinic, you know, executives who
are listening, I think there isa lot of regulatory changes
coming. And so this to me is theperfect time for kind of digital
transformations in healthcarebecause for 30+ years, it's been
(22:45):
the same thing. We've been doingthings the same way. There's
been no modernization at all.
But now the Center for Medicareand Medicaid Services, if you
look up 0057- F, they arerequiring that there is
increased transparency andproved processes in the prior
(23:06):
authorization spacespecifically. So by 01/01/2027,
all insurance companies aregoing to be required to be able
to transmit prior authorizationselectronically, which is going
to be a huge shift. They'regoing to have to turn those non
urgent requests around in sevendays, whereas now it's at least
fourteen days for most routinerequests. And there has to be
(23:27):
improved transparency andvisibility. So I think the great
thing for us in healthcare rightnow is we finally have
regulatory pressure forcingchange in this really archaic
space.
So it's a beautiful time andopportunity for practices to
leverage that and to improvetheir own processes so that they
(23:48):
can benefit from that, right? Ifyour practice is still faxing
and portal hopping, once theinsurance companies are required
to do these electronictransmissions, you're really
missing out on an opportunity todecrease that turnaround time
for your patients and to improvethat process for your staff. So
I think that's another thingthat I would encourage, leaders
(24:11):
out there listening to look intoand to really come up with a
plan for how they're going toleverage that for their own
practice, because we know thatless than 0.5% of practices are
ready today.
Daniel Williams (24:22):
Wow. Okay. So switching gears.
Paola Ballester (24:26):
Yes.
Daniel Williams (24:27):
We did talk about something really
interesting. I think this can behelpful to our women listeners.
You talked about how a lot oftimes in very high level
meetings that you're in inhealth care, in the
entrepreneurial setting, youhave found yourself often the
only woman in some of thesemeetings. But you have had an
(24:48):
incredibly successful career. Sowhat advice can you give to our
women listeners today in howthey navigate that space, how
they succeed in healthcare,succeed in the entrepreneurial
world?
What have you leaned into tofind that success?
Paola Ballester (25:05):
Oh, that's such a great question and probably a
topic of for an entire series ofRight? But I think, you know,
every person should define theirown success individually. And I
think, you know, for women thatwant to and are in leadership
roles is to own theirconfidence, own their courage,
(25:28):
own their expertise. And I thinkto not shy away from
opportunities, not shy away fromchallenges. We deserve to be in
the spaces just as much asanyone else.
I think a lot of times women,particularly and more so than
men, have imposter impostersyndrome and kind of worry that
(25:49):
they're not qualified, thatthey're not deserving of those
opportunities. We know thatthere are inherent systemic
barriers as well. And so I justchallenge women to believe in
themselves first and not to shyaway from, you know,
representing themselves,demanding their worth and their
value and showing up in thosespaces and showing, you know,
(26:13):
what we can do. From everythingon the clinical side, we know
that many studies have shownbetter outcomes with female
physicians, surgeons, and we areincreasingly taking up and
expanding in our leadershipcapabilities and roles. And so
own that and be a part of thatand tell your story.
(26:33):
It's been an interesting journeyso far, and and I'm excited to
kind of help represent that forother women.
Daniel Williams (26:39):
Yeah. Last question. Because I really do
like to get to know the guestoutside of the work they do. So
you were sharing with me thatyou are an enthusiastic
basketball mom, and I'm a I'm aformer cheer dad. My daughter
Nice.
Was a cheerleader both in highschool and college. And so I was
(27:00):
cheering along with her, and wejust met at Thanksgiving and
went So through some of thecheers together what has that
experience been like where youcan really focus on the kids and
watching them play basketball,maybe show them how to make a
good two handed bounce pass,that sort of thing. But what
what has that been like?
Paola Ballester (27:21):
So I am the proud mom to an almost 13 year
old son named MJ, and he is anavid basketball player. This is
the first year that he's beenable to play for his middle
school team, which has been somuch fun. He's also been
involved in many rec leagues andAAU teams. So, you know, I think
(27:45):
even going back to your previousquestion, right, is how do we do
it all? And I think it's youhave to have your firm
boundaries.
What is important to you? Whatis non negotiable? And how do
you make everything else workaround it? And I think to me,
the biggest parts of my successI attribute to, you know, having
(28:05):
community and that's chosenfamily and community, my
girlfriends, my family that areall so incredibly supportive and
cheer for me every step of theway. But also my son because
he's my motivation.
He's why I do everything that Ido. He's why I've chosen the
role that I've chosen because tome personally, it was really
(28:26):
important that I can go to thosebasketball games and I can go to
his tournaments. And yeah, ofcourse, I miss a few every now
and then. I have to workweekends. I have to work night
shifts, But I do my best toprioritize scheduling my
clinical shifts and my meetingsin times that won't conflict
with me being able to be hisnumber one fan.
(28:47):
So, I am one of those loud momsin the stands. I'm cheering. I
have an amazing group ofbasketball moms that we've all
become close and friends with,and we love, you know, cheering
our boys on together. So thoseare the things that fill my cup
and bring me a lot of joyoutside of the daily kind of
grind of medical practice andentrepreneurial life. Those are
(29:09):
the things that keep me centeredand grounded and really bring me
a lot of joy.
Daniel Williams (29:14):
That is so cool. Well, Doctor. Paula
Ballester, a hospitalist and anentrepreneur or founder of
EasyPA, thanks for joining ustoday.
Paola Ballester (29:24):
Absolutely. It was a pleasure. I really
appreciate you.
Daniel Williams (29:27):
Yeah. Everybody listening, we're going to put a
lot of information in theepisode show notes. We might
even put Doctor. Ballester'srecipes from Thanksgiving, if
we're lucky. Who knows?
But I just want to say, thankyou all for being MGMA podcast
listeners.
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The official podcast of comedian Joe Rogan.
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If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.